Dr. Ellsworth on Low Testosterone, Type 2 Diabetes and Belly Fat
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Today, we’re going to be talking about testosterone and how it connects to belly fat and what are sometimes called metabolic syndrome and type 2 diabetes. These are some important issues that I think you’ll really see as critical to understand for men to be healthy in midlife.

Testosterone is Helpful in Weight Loss
Testosterone has actually been known to be helpful for weight control for a long time. They’ve actually been using it intermittently over the years but a recent study that was in the European Congress on Obesity in 2012, it was a very interesting study that they were reporting on because it was a surprise to them. They were actually following older overweight men receiving injections of testosterone for up to 5 years. It was primarily to treat the symptoms and issues of low testosterone. They found that the men who were treated the longest lost more than 30 pounds on average, over the course of the study it showed improvements in their blood pressure, the glucose, and the LDL. What was interesting is they said, “Wow! This is really surprising.” The study was not performed for the purpose of promoting weight loss. This was an incidental meeting and what just happened, they weren’t trying to make it happen and was entirely unexpected. Think about that: losing 30 pounds accidentally. That’s a good deal if you need to lose weight, right? This happened when they were just looking at the effects of testosterone and they were just trying to document the overall safety and as an incidental, a kind of accidental finding. “Wow! Look at these guys, 30 pounds.”

They have actually found that not everybody loses that much, but you typically do see a trend towards dropping fat and increasing muscle. In fact, they reported in the Journal of Clinical Endocrinology, a 13% reduction of fat. That’s a very big number, it’s 13%, and a lot of people wonder, “Well, am I losing muscle?” The muscle went up 7% and bone density went up 5%. These are all things that typically go the opposite direction when guys are in midlife. You tend to get more fat, less muscle, and bone density drops. With putting the testosterone back in, we actually can show reversal of that.

Testosterone for Diabetes Treatment
In Europe, they’ve used testosterone to treat diabetes for a while. For some reason, it’s not really been a trend in the United States. They’ve used testosterone since the 1960’s and when they get the testosterone levels optimal, they found it easier to control the glucose. Well, it turns out, we’re now findings in studies that have been done more recently that there’s a great deal of evidence that that’s actually a really good idea and the testosterone actually drops blood sugar – it drops insulin levels. This is with type 2 diabetes and the hemoglobin A1c, which is your average blood sugar over the past three months, that drops as well.

They’ve done formal studies and they presented the study in 2011 in an endocrinology meeting. This is striking. If you’ll bear with me going through a little bit of detail here because you’ll find this fascinating. They looked at 587 diabetic men and they followed them and they only gave testosterone to the men who had fairly low testosterone. They were using total and it was less than 300.

Here’s what they saw. In these older men with low testosterone who are not treated, did not receive any treatment, over the 6-year period, there were 20% mortality, so one out of five died. Those with normal testosterone levels, now I’d argue some of those didn’t have great levels, but they said they have a 9% mortality even with that fairly low cut off. The point you want to see is 9% versus 20%. Those with good testosterone levels had a 50% lower risk of dying over that time period. That was naturally. That was without doing anything.

Now you may be wondering, “Okay. Well, if you put the testosterone back in, does it work or is it just a reflection of health?” That’s an argument some people make. They just had better testosterone because they’re healthy in general, so they’re living longer because they’re healthier. Well, guess what. When they replace the testosterone to reasonable levels, they had the exact same mortality as those with normal testosterone. It was 8.6, actually a little bit better. You had, instead of 20% mortality in the low testosterone group, those with low testosterone had a drop to 8.6. In other words, that’s a 50% plus reduction in the risk of dying.

Do you know anything that’s ever been discussed that reduces the risk of dying by over 50%? It’s not common in medicine. By the way, statin medications do not do anything close to this. The risk of statin drugs has been estimated to maybe reduce the risk of dying by half a percent a year in some studies. Of course it can go up in other areas. So it’s a trivial change with these statins, whereas testosterone has been shown to make a dramatic difference. Testosterone is fantastic for men with diabetes but it’s also important if you have belly fat.

Spare-Tire Syndrome
The spare-tire syndrome that a lot of us guys have to deal with or, at least, battle is the fact that, as our testosterone levels drop, we tend to be more prone to belly fat. Now, this gets into a vicious cycle because you know what fat does? It makes estrogen. The little bit of testosterone you have gets converted into estrogen because it has an enzyme called an aromatase. Well, you know what guys feel like when their estrogen level is high? Lousy. In fact, it’s just a lot like low testosterone: tired, depressed, and they also tend to get your triglycerides going up and your HDL’s low.

So, if you want to get rid of the spare-tire, obviously, I’m not going to say just add testosterone because while that my work, it’s going to actually require, in most cases, that you actually change the way you eat and exercise. Cutting out sugars and starches, limiting alcohol, getting enough sleep, getting exercise. But when you do that, you’ll have less fat tissue to make estrogen and then you’ll typically respond really nicely to testosterone. Occasionally, especially initially before you lose a lot of body fat, we have to give extra things to block the conversion of testosterone to estrogen, but men will see a significant improvement in their overall health. Their muscles improve, their tones improve, their moods improve. And overall, as I’ve talked about the issues with low testosterone where you’re feeling tired and grumpy and anxious and indecisive and just blah in general, you feel better.

But what I want to talk about and emphasize today is the fact that we’re not just talking about feeling better. We’re talking about up to a 50% reduction in the risk of dying, at least in diabetic men has been shown, by optimizing testosterone levels. Please do not put testosterone into the: “Well, it’s kind of nice to do that but I don’t know whether it’s a good idea for me because I’m doing okay, I’m getting by.” One of the most important things we need to know about our overall health is: Is my testosterone where it should be? Is it optimal? That’s not really something you should consider optional for you and your loved ones. Make sure that you’re addressing this important issue.